N.S. risks losing dozens of physicians over a potential new policy

The College of Physicians and Surgeons of Nova Scotia is drafting the Professional Standard Regarding Conscientious Objection, which includes a policy that would force doctors to provide an ‘effective referral’ for surgical or medical treatments that go against their values or beliefs.

This usually happens for cases like medical assistance in dying (MAID), abortion, and gender-affirming care.

The draft defines ‘effective referral’ as a referral made in good faith to a non-objecting, available, and accessible physician, other health-care professional or agency.

“A physician needs to maintain their own integrity, whether it’s because of their religious beliefs or moral conviction. For us, a referral is a recommendation for services and we’re not able to provide a formal recommendation,” said Larry Worthen, executive director of Christian Medical and Dental Association of Canada (CMDA).

A total of 24 physicians in Nova Scotia have signed a letter, indicating that they cannot follow the policy, and that if it is put in place, they will have no choice but to either leave the province to practice elsewhere or retire early.

The current draft of the Professional Standards Regarding Conscientious Objection, which includes a policy that would force doctors to provide an ‘effective referral’ for surgical or medical treatments that go against their values or beliefs. “If there is a complaint from a patient, the college has said they will discipline doctors and once that happens that will affect their ability to practice. A doctor can’t afford to get a black mark on their record. It will affect their ability to move to another province,” explained Worthen.

The doctors against the policy would instead prefer to simply provide information and assist the patient in accessing it, but nothing more.

“We want to listen to the patient and determine what the nature of the suffering is, and then go through with them all the options that they have. We are prepared to tell them how to access it and that they can access it without a referral,” said Worthen.

In the Canadian Medical Association, there are five virtues that doctors have to uphold, including compassion. That along with the others have guided every aspect of Dr. Linda Gagnon’s 33-year career, but she believes the policy puts that risk.

“I’m okay with giving information about MAID, I just can’t in conscience make an effective referral,” she said.

The policy would not work with her religious beliefs. Gagnon said she is concerned with the ways this will impact family medicine.

“It has enough problems right now recruiting and keeping people that they don’t need this on top of it. It’s decreasing the amount of family doctors.”

The associate professor at Atlantic School of Theology, David Deane, said for representatives from minority religious communities need doctors to be faithful to their conscience first and foremost.

“Any state or any confederation which refuses the right of people from minority groups, whether that be Muslim or Christian, and others, is a problem.”

He said language defining effective referral can be extremely important in circumstances like this for some religions.

“From a Catholic perspective, being complicit in a system that is radically immoral is problematic. If the state said that you’ve got to be part of this process, which would lead to the euthanization of this person, then you’ve got to resist that, and whether that’s in a referral or suggesting other doctors, you were still part of that chain,” said Dean.

Doctors Nova Scotia, an association representing physicians in the province, said it would be disappointed and saddened if doctors were to leave the practice, however, it supports an effective referral system.

“The patient’s right to autonomy are top and we need to respect that. We need to help our patients at their most vulnerable times to be able to access those services,” said Dr. Leisha Hawker, past-president of Doctors Nova Scotia.

Hawker said patient autonomy is extremely vital and has to be respected.

“We need to set aside our own beliefs whether religious or moral views. I don’t often agree with patients choices but I always do my best to support them in accessing all of the services they’re entitled.”

Physician and bioethics professor at Dalhousie University, Dr. Tim Holland said removing the requirement of an effective referral leaves a lot of concerns for patients who are in need of assistance.

“A lot of patients at the end of life that are requesting to relieve their suffering don’t even have the ability to dial on a phone, may not have access to a telephone, so without having a physician that can help facilitate them getting the care they need, these patients are not going to have access to what it is they’re requesting.”

The current standard in Nova Scotia states that the responsibility of a physician who is unwilling or unable to participate in MAID must complete an ‘effective-transfer’ of care. CMDA has said that this language is still a concern to them, but Dr. Holland drew criticism of this.

“They’re not even allowing us to work with the language to come to a meaningful compromise that guarantees patient access. An effective transfer allows a physician to transfer a patient to a colleague across the hall who might be able to do that referral. Simply providing a phone number is not access to care.”

The only other province that uses ‘effective referral’ in its policy is Ontario. According to Dr. Holland, other provinces like Alberta have doctors that refer patients to an end of life agency that then considers MAID or palliative care.

He believes the physicians with conscientious objection should instead work with the province in finding alternative solutions.

“This is a more logistics issue. Physicians who have conscientious objection should work with Nova Scotia Health [and] should work with the province of Nova Scotia to find ways that our system can facilitate access to patient care and facilitate their conscience. Simply saying ‘I don’t want to refer the patient’ and leaving them with a phone number when they can’t access that service through just a phone number is not enough.”

In a statement to CTV News, the College of Physicians and Surgeons of Nova Scotia said, “the draft Professional Standard regarding Conscientious Objection is currently in the consultation process. Once we receive all the feedback regarding this standard it will be brought to the Professional Standards Committee for their review and consideration.”

CTV News also reached out to the province about the possibility of losing 24 doctors and whether they will be address this, but were told that they would not be able to meet today’s deadline.

“With March break it is proving difficult to reach people for the information needed,” the province said.

For more Nova Scotia news visit our dedicated provincial page.